COVID-19 vaccine-induced immune thrombotic thrombocytopenia

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly transmissible and pathogenic coronavirus responsible for the pandemic coronavirus disease 19 (COVID-19). It has significant impact on human health and public safety along with negative social and economic consequences. Vaccination against SARS-CoV-2 is likely the most effective approach to sustainably control the global COVID-19 pandemic. Vaccination is highly effective in reducing the risk of severe COVID-19 disease. Mass-scale vaccination will help us in attaining herd immunity and will lessen the negative impact of the disease on public health, social and economic conditions. The present pandemic stimulated the development of several effective vaccines based on different platforms. Although the vaccine is safe and efficacious, rare cases of thrombosis and thrombocytopenia following the use of vaccination with the ChAdOx1 CoV-19 vaccine (AstraZeneca, University of Oxford, and Serum Institute of India) or the Ad26.COV2.S vaccine (Janssen/Johnson & Johnson) have been reported globally. This review focussed on the definition, epidemiology, pathogenesis, clinical features, diagnosis, and management of vaccine associated thrombosis.

Recommendations on the Management of Patients with Immune Thrombocytopenia (ITP) in the Context of SARS-CoV-2 Infection and Vaccination: Consensus Guidelines from a Spanish ITP Expert Group

“…Regarding VITT, thrombocytopenia and venous and/or arterial thrombosis occur, which may be in atypical locations, 5–30 days after the first vaccination against SARS-CoV-2 with AstraZeneca-Oxford or Johnson & Johnson. Elevated D-dimer is detected in blood and associated with positive anti-PF4 antibodies (Ab) detected by enzyme-linked immunosorbent assay (ELISA) [ 37 , 38 ].…”

Uncommon Etiologies of Acute Abdominal Pain: A Case Report on Omental Infarction

“…Although the exact cause of omental infarction is usually unknown [2], the two most commonly identifiable etiologies include vascular torsion and thrombosis secondary to a hypercoagulable state [7,8]. For example, COVID-19 infection and the COVID-19 vaccine are linked to hypercoagulability and direct viral effects on the gastrointestinal tract [7][8][9]. Although to date a link between the COVID-19 vaccine and omental infarction has not been reported, multiple cases of omental infarction have been reported in COVID-19-positive patients, and it is believed to be due to a higher propensity toward arterial thromboembolism in this patient population [8,9].…”

“…For example, COVID-19 infection and the COVID-19 vaccine are linked to hypercoagulability and direct viral effects on the gastrointestinal tract [7][8][9]. Although to date a link between the COVID-19 vaccine and omental infarction has not been reported, multiple cases of omental infarction have been reported in COVID-19-positive patients, and it is believed to be due to a higher propensity toward arterial thromboembolism in this patient population [8,9]. Other causes included hernias, trauma, and neoplasms [5].…”

To study the effect of ‘Covishield’ vaccination on pre-donation platelet counts of plateletpheresis donors

“…There are 7 reported cases of vaccine-induced thrombotic thrombocytopenia in India and further individual case reports are emerging with raised D-Dimer and PF4 IgG antibody levels. 10 , 11 , 12 However, no research publication revealed the impact of only thrombocytopenia on plateletpheresis donors. We undertook this case-control study to demonstrate the effect of the Covishield vaccination on the deferral rates of our healthy voluntary platelet donors.…”